Mathur, M; (2014) Exploring the Determinants of Social Gradient in Oral Health among Adolescents Living in the City of New Delhi. Doctoral thesis , UCL (University College London).

Abstract

The overall aim of this research study was to assess whether there are socioeconomic gradients in various oral health outcomes (caries experience, decayed teeth, traumatic dental injuries and self-rated oral health) of adolescents, 12-15 years of age living in the city of New Delhi, India and to assess the various material, psychosocial and behavioural factors influencing this gradient. Various studies conducted across the world have reported that children and adolescents belonging to lower socioeconomic groups compared to higher socioeconomic groups have poorer oral health status. This relationship is present in a stepwise manner across the entire spectrum of socioeconomic hierarchy commonly known as social gradient. Studies conducted in India conversely are inconclusive and provide conflicting evidence. No attempt has been made in assessing the role of psychosocial (social capital and social support), behavioural and material (standard of living) factors in affecting the socioeconomic gradients in oral health in India especially considering adolescents living in deprived neighbourhoods.The proposed study is an attempt to address this gap in the scientific literature. A cross sectional survey was conducted with a sample of 1386 adolescents living in 3 diverse residential areas of New Delhi (urban slums, resettlement colonies and middle/ upper middle class homes). A clinical examination was undertaken to assess the oral health status of the sample and an interviewer administered questionnaire was used to gather relevant behavioural and social data. Disparities in various oral health outcomes was found between adolescents from different residential areas living in New Delhi.Clear monotonic socioeconomic gradients were observed in caries experience and number of decayed teeth while a threshold effect was observed in dental trauma with adolscents from urban slums and resettlement colonies showing significantly higher levels of dental trauma in comparison to their middle class counterparts. No significant gradient was observed in poor self-rated oral health.Different material, psychosocial and behavioural factors had no significant impact on the observed gradients in various oral health outcomes showing that area of residence is a very strong predictor of oral health and there is a need to design policies which aims at improving health by taking action on the broader structural determinants of health.

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